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Graduate
Nursing Program
GNOSIS
The Graduate Nurse Orientation-Success in Specialty
(GNOSIS) program has been developed as an orientation program
for new graduate nurses at High Point Regional Health System
(HPRHS). GNOSIS is designed to prepare the new nurse to function
competently and safely within the acute care setting.
Upon completion of general nurse orientation, which is geared
toward introducing the organization and the care delivery
model standards of nursing practice, the new nurse will begin
the generalist (basic Medical-Surgical) portion of the GNOSIS
program.
The basic program consisting of weekly classes and carefully
planned clinical experiences will provide the framework for
development of nursing knowledge and clinical skills related
to the nursing process, communication, socialization, teamwork,
disease process, patient management across the continuum of
care, resource management, legal aspects of care, psychomotor
skills, and clinical practice.
Nurses successfully completing the basic GNOSIS program will
advance to unit-specific orientation in assigned clinical
specialty.
The GNOSIS Program
GNOSIS is an eleven-week long orientation program that all
graduate nurses/nurses with less than one year’s acute
care work experience are required to complete when hired at
High Point Regional Health System. The program has been in
place since February 1998.
The program consists of planned clinical and classroom days,
weekly  meetings
with the program director and educators, and opportunities
to see all areas of the health system. Participants work the
shifts they were hired for and all clinical is designed to
help the nurse attain generic nursing knowledge/skills and
to supplement the class topics. Clinical shifts follow the
weekly classes. Classes are held on Mondays and some Tuesdays
with topics including:
• Physical Therapy – intensive education
on all patient transfer techniques, patient
care equipment, body mechanics, and prevention of
back injuries (4 hours). Participants spend 4 hours with PT
staff practicing skills covered during class.
• Basic Patient Care Skills – verification
of ability to correctly perform all NA skills
and tasks; this is done to ensure the nurse understands the
role and performance of the NA since he/she
will be responsible for precepting and verifying
the new NA’s performance (8 hours). Participants
spend clinical time attaining competency in all NA skills/tasks;
are paired with NA and RN clinical hours.
• Basic Nursing Care Skills – in-depth
review of physical assessment techniques;
review and discussion of admission/transfer/discharge documentation
and correct use of forms; review and discussion of risk management
issues and documentation of patient or employee incidents;
review and practice with various patient care/equipment devices
(foley and NG insertions/maintenance/removal, hypo/hyperthermia
blanket use, etc.); practice admitting/transferring/discharging
each other using fictional information (8-12
hours; depends on number in the class). Participants are
required to perform 5 admissions/transfers/discharges without
assistance to be considered competent in
this area. Clinical is spent practicing
assessments along with required admissions/transfers/discharges.
• Basic Cardiac Care – cardiac A&P,
assessment, common drugs/procedures, and
common disease processes, and how patients are
cared for at HPRHS is discussed; the Case Managers for CHF
and MI review the pathway for these patients
(8 hours). Clinical is focused on caring
for patients with CHF, stable post NI/PTCI patients and patients
with dsysrhythmias. Participants spend 4-8 hours in Cardiac
Cath Lab/Cardiology department.
• Basic Rhythm Interpretation – identification
of common sinus, atrial, and ventricular
rhythms, assessment and brief explanation of treatments
(8 hours).
• Basic Neurovascular Care – neurovascular
A&P, assessment, common drugs/procedures,
and common disease processes and how patients are
cared for at HPRHS; appropriate Case Managers present pathways
(8-12 hours). Clinical is focused on caring for patients with
CVA, TIA, stable carotid endarterectomy.
• Wound Care – class focusing on care of
wounds, both surgical and decubiti; in-depth
review of skin care protocols used at HPRHS; methods
for promoting wound healing; dressing changes (8 hours). Spend
4 hours in the Wound Care Center.
• Spiritual/Ethical Care – discussion of
Ethics Committee and how staff interact
with members; use of committee with patient issues; discussion
of code/no-code issues. Facilitated by member of hospital
Pastoral Care staff sand educator with strong
interest in ethics. (6hours)
• Pain Management/End of Life Care – in-depth
class on pain management principles; methods
for pain control; review of pain medications
(8 hours).
• Charge Nurse Class – this is scheduled
for the 11th or 12th month of employment.
It is a 6 hour class designated to help prepare the RN to
assume the charge nurse role.
• Preceptor Class – this is scheduled for
the 12th -15th month of employment. The
nurses receive a notice from program director reminding
them to register for this class and the Charge Nurse class.
Also the Nursing Directors receive an email
reminder asking them to facilitate getting
the nurses to the class.
Everyone working days/evenings meet Friday afternoons to discuss
the experiences of the week. Questions are asked and experiences
shared with the group. These meetings often involve review
of policy/procedure and discussion of what is the ‘usual’
at HPRHS.
The final class is a combination of discussion and ‘graduation’
from the program. All participants receive a certificate.
All of the Nursing Directors and Chief Nursing Officer attend
the graduation.
COURSE OBJECTIVES
1. Identify personality type and learning style
to promote optimal pairing
of the new nurse with the nurse preceptor/clinical teacher.
2. Apply principles of body mechanics, safety,
and infection control in clinical
practice.
3. Develop competency in providing basic patient
care.
4. Develop competency in information management
and documentation.
5. Demonstrate proficiency in physical and psychosocial
assessment across the
life span.
6. Manage patient care across the continuum to
include patient admission,
transfer, discharge, education, consultation, and use of appropriate
resources to meet individualized patient care needs.
7. Demonstrate competency in medication administration
and pain management, blood/blood
product administration, nutritional and intravenous
therapy.
8. Provide care to the stable, uncomplicated patient
experiencing cardiac,
neurovascular, respiratory, diabetic, renal, and gastrointestinal dysfunction/disorders.
9. Identify resources available for patient/family
and staff needs related
to spiritual/ethical issues.
10. Provide care to patients experiencing behavioral health
needs to include substance
abuse, withdrawal, and detoxification in the acute care
setting.
COURSE EVALUATION
Knowledge and clinical competencies of the new nurse is assessed
weekly based on the course objectives with input from the
preceptor, manager, educator, and orientee self-evaluation.
Course content, clinical experiences and effectiveness/performance
of the educator, manager, and preceptor will be provided by
the new nurse and utilized for ongoing program evaluation
and improvement.
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